Sleep quality is associated with vasopressin methylation in pregnant and postpartum women with a history of psychosocial stress.

BACKGROUND: The relationship between disturbed sleep and stress is well-documented. Sleep disorders and stress are highly prevalent during the perinatal period, and both are known to contribute to a number of adverse maternal and foetal outcomes. Arginine vasopressin (AVP) is a hormone and a neuropeptide that is involved in stress response, social bonding and circadian regulation of the sleep-wake cycle. Whether the AVP system is involved in regulation of stress response and sleep quality in the context of the perinatal mental health is currently unknown. The objective of the present study was to assess the relationship between levels of cumulative and ongoing psychosocial risk, levels of disordered sleep and AVP methylation in a community sample of pregnant and postpartum women. METHODS: A sample of 316 participants completed a battery of questionnaires during the second trimester of pregnancy (PN2, 12-14 weeks gestation), third trimester (PN3, 32-34 weeks gestation), and at 7-9 weeks postpartum (PP). Disordered sleep was measured using the Sleep Symptom Checklist at PN2, PN3 and PP; cumulative psychosocial risk was assessed with the Antenatal Risk Questionnaire (ANRQ) at PN2; salivary DNA was collected at the follow-up (FU, 2.9 years postpartum); and % methylation were calculated for AVP and for two of the three AVP receptor genes (AVPR1a and AVPR1b). Women were separated into high (HighPR) and low (LowPR) psychosocial risk groups, based on their scores on the ANRQ. RESULTS: Women in the HighPR group had significantly worse sleep disturbances during PN2 (p < .001) and PN3 (p < .001), but not at PP (p = .146) than women in the LowPR group. In HighPR participants only, methylation of AVP at intron 1 negatively correlated with sleep disturbances at PN2 (rs=-.390, p = .001), PN3 (rs=-.384, p = .002) and at PP (rs= -.269, p = .032). There was no association between sleep disturbances and AVPR1a or AVPR1b methylation, or between sleep disturbances and any of the AVP methylation for the LowPR group. Lastly, cumulative psychosocial stress was a moderator for the relationship between AVP intron 1 methylation and disordered sleep at PN2 (p < .001, adjusted R2 = .105), PN2 (p < .001, adjusted R2 = .088) and PP (p = .003, adjusted R2 = .064). CONCLUSIONS: Our results suggest that cumulative psychosocial stress exacerbates sleep disorders in pregnant women, and that salivary DNA methylation patterns of the AVP gene may be seen as a marker of biological predisposition to stress and sleep reactivity during the perinatal period. Further research is needed to establish causal links between AVP methylation, sleep and stress.

CPAP Treatment Adherence in Women with Obstructive Sleep Apnea.

Untreated obstructive sleep apnea (OSA) has numerous negative health-related consequences. Continuous positive airway pressure (CPAP) is generally considered the treatment of choice for OSA, but rates of nonadherence are high. It is believed that OSA is more prevalent among men; therefore understanding how OSA presents among women is limited and treatment adherence has received little research attention. For this study, 29 women were recruited from primary care offices. They completed a questionnaire battery and underwent a night of nocturnal polysomnography (PSG) followed by a visit with a sleep specialist. Women diagnosed with OSA were prescribed CPAP; 2 years later CPAP adherence was evaluated. Results show that approximately half the sample was adherent. There were no significant differences between adherent and nonadherent women on OSA severity; however CPAP adherent women had worse nocturnal and daytime functioning scores at the time of diagnosis. Moreover, when the seven nocturnal and daytime variables were used as predictors in a discriminant analysis, they could predict 87% of adherent and 93% of the nonadherent women. The single most important predictor was nonrefreshing sleep. We discuss the implications of the findings for identifying women in primary care with potential OSA and offer suggestions for enhancing treatment adherence.

Doxepin and cognitive behavioural therapy for insomnia in patients with Parkinson's disease -- a randomized study.

INTRODUCTION: Although a variety of pharmacologic and non-pharmacologic treatments are effective for insomnia in the general population, insomnia in Parkinson's disease differs in important ways and may need different treatments. No studies have conclusively demonstrated effective insomnia treatments in Parkinson's disease. METHODS: We conducted a three-arm six-week randomized pilot study assessing non-pharmacologic treatment (cognitive behavioural therapy with bright light therapy) or doxepin (10 mg daily), compared to an inactive placebo in Parkinson's patients with insomnia. Sleep outcomes included insomnia scales, clinical global impression, sleep diaries and actigraphy. Secondary outcomes included motor severity, fatigue, depression and quality of life. RESULTS: 18 patients were randomized, 6 to each group. Compared to placebo, doxepin improved the Insomnia Severity Index (-9 ± 5.4 vs. -2 ± 3.9, p = 0.03), the SCOPA-night score (-5.2 ± 1.5 vs. -2.3 ± 2.8, p = 0.049), the Pittsburgh Sleep Quality Index-sleep disturbances subscale (-0.5 ± 0.5 vs 0.2 ± 0.4, p = 0.02), and both patient and examiner-rated clinical global impression of change (1.7 ± 0.8 vs. 0.5 ± 0.8, p = 0.03 and 1.4 ± 0.5 vs. 0.3 ± 0.5, p = 0.003). On secondary outcomes doxepin reduced the fatigue severity scale (p = 0.02) and improved scores on the Montreal Cognitive Assessment (p = 0.007). Non-pharmacological treatment reduced the Insomnia Severity Index (-7.8 ± 3.8 vs. -2.0 ± 3.9, p = 0.03), and the examiner-reported clinical global impression of change (p = 0.006), but was associated with decline in Parkinson Disease Questionnaire-39. There were no changes in other primary and secondary outcomes, including actigraphy outcomes. Adverse events were comparable in all groups. CONCLUSION: Doxepin and non-pharmacologic treatment substantially improved insomnia in Parkinson's disease. These potential benefits must be replicated in a full confirmatory randomized controlled trial.

[Blindness and disability due to pathology of the organ of vision in Russia].

The paper covers the issues of blindness and disability associated with pathology of the organ of vision. It lists the principal causes of blindness in the developed and developing countries. Basic tendencies in solving the problems of blindness and weak sight are defined. The issues of disability due to pathology of the organ of vision and the ways of its reduction are discussed.

[Present-day positions of the clinical-and-social ophthalmology]. / Sovremennye pozitsii kliniko-sotsial'noi oftal'mologii.

Outlined in the paper are the basic trends and tasks of clinical-and-social ophthalmology--research and practice related with the medical-and-social consequences of disabling visual impairments as well as of blindness and disability due to vision. They comprise: 1) A study of the epidemiological, social-and-hygienic and clinical-and-ophthalmologic aspects of blindness and disability; 2) Scientific elaboration of methodological, clinical, social and managerial positions and criteria of ophthalmologic and of medical-and-social expertise; 3) A theoretical definition of the methodological principles for medical-and-social rehabilitation of the disabled due to vision. Data are presented of the rate of blindness and disability due to ophthalmic pathologies in the Russian Federation. The modern standpoints of ophthalmologic medical-and-social expertise and rehabilitation of persons with visual lesions are elucidated.

The Hebrew version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation into the Hebrew language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Hebrew CHAQ-CHQ were fully developed with 3 forward and 3 backward translations. A total of 144 subjects were enrolled: 80 patients with JIA (12% systemic onset, 34% polyarticular onset, 23% extended oligoarticular subtype, and 31% persistent oligoarticular subtype) and 64 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the JIA patients having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Hebrew version of the CHAQ-CHQ is a reliable, and valid tool for the functional, physical and psychosocial assessment of children with JIA.

How is good and poor sleep in older adults and college students related to daytime sleepiness, fatigue, and ability to concentrate?

We compared good sleepers with minimally and highly distressed poor sleepers on three measures of daytime functioning: self-reported fatigue, sleepiness, and cognitive inefficiency. In two samples (194 older adults, 136 college students), we tested the hypotheses that (1) poor sleepers experience more problems with daytime functioning than good sleepers, (2) highly distressed poor sleepers report greater impairment in functioning during the day than either good sleepers or minimally distressed poor sleepers, (3) daytime symptoms are more closely related to psychological adjustment and to psychologically laden sleep variables than to quantitative sleep parameters, and (4) daytime symptoms are more closely related to longer nocturnal wake times than to shorter sleep times. Results in both samples indicated that poor sleepers reported more daytime difficulties than good sleepers. While low- and high-distress poor sleepers did not differ on sleep parameters, highly distressed poor sleepers reported consistently more difficulty in functioning during the day and experienced greater tension and depression than minimally distressed poor sleepers. Severity of all three daytime problems was generally significantly and positively related to poor psychological adjustment, psychologically laden sleep variables, and, with the exception of sleepiness, to quantitative sleep parameters. Results are used to discuss discrepancies between experiential and quantitative measures of daytime functioning.

What do older good and poor sleepers do during periods of nocturnal wakefulness? The Sleep Behaviors Scale: 60+.

To determine whether older good and poor sleepers with and without insomnia complaints differ in the nature of activities they engage in during periods of nocturnal wakefulness, the authors developed and evaluated the Sleep Behaviors Scale: 60+. Good sleepers (n = 163), low-distress poor sleepers (n = 49), and high-distress poor sleepers (n = 28) were compared on this measure as well as on sleep parameters, personality, lifestyle, and cognitive-affective variables. Findings indicate good psychometric properties for the new measure, offer a rationale for examining the frequency of the nocturnal behaviors reflected by the measure's 4 subscales (Active Behaviors, Relaxation, Cognitive Arousal, and Medication), and suggest a possible role for these behaviors in the etiology and treatment of insomnia.

Poor sleepers who do not complain of insomnia: myths and realities about psychological and lifestyle characteristics of older good and poor sleepers.

Psychological adjustment, lifestyle, and sleep parameters were investigated in 634 older community residents. Participants were divided into three categories: good sleepers, poor sleepers experiencing high distress, and poor sleepers experiencing minimal distress. Results indicate that (1) highly distressed poor sleepers manifested an anxious, depressed, negative cognitive-affective set; (2) many coped well with age related changes in sleep quality--they resembled good sleepers in the relative absence of psychological maladjustment they displayed; (3) the three groups had similar lifestyles, but they differed in the cognitive-affective evaluation of their activities, (4) the insomnia complaint is itself multifaceted and is comprised of three distinct elements--difficulty sleeping, distress, and daytime fatigue; (5) sleep practices (e.g., naps, bedtimes) are not implicated in chronic poor sleep; and (6) many commonly held assumptions about sleep disruptions in older individuals are myth rather than reality. Implications for better understanding and treating insomnia in older individuals are discussed.

[Insomnia and its treatment in aged persons: a new approach]. / L'insomnie et son traitement chez les personnes âgées: une nouvelle approche.

Existing hypotheses regarding psychological mediation of disorders in initiating and maintaining sleep only partially explain the phenomenon of insomnia, particularly in aging individuals. In this article we review existing nonpharmacological treatments of insomnia and propose a new way of conceptualizing and treating disorders of initiating and maintaining sleep. The model, based on cognitive and information processing factors, is then used to propose novel approaches to intervention. Because of the prevalence of sleep disruptions in older adults and the limitations of existing pharmacological and psychological treatments with this population, the assumptions of the model and the proposed intervention are explored with particular reference to aging individuals.

Evaluation of the sexual consequences of surgery: retrospective and prospective strategies.

To assess the impact of a stressor, it is desirable to evaluate affected individuals' status both prior to and following a stressful event. Because of the difficulties inherent in prospective designs, investigators often ask people who have experienced an aversive event to evaluate their prestressor adjustment retrospectively. Do such retrospective evaluations provide a reasonable alternative to prospective assessment? To answer this question we compared retrospective and prospective data gathering procedures in the evaluation of sexual adjustment after prostate surgery. One hundred fifty-two married males who had undergone prostatectomy for benign prostatic enlargement completed a battery of measures which evaluated pre- and postsurgical sexual adjustment either prospectively (i.e., before and after surgery) or retrospectively (i.e., ratings made after surgery of both pre- and postsurgical adjustment). Retrospective assessment indicated considerable sexual deterioration pre- to postsurgery. In subjects tested prospectively, however, the results showed that surgery had little impact on sexual adjustment. Moreover, direct comparisons of retrospective and prospective methodologies reveal that discrepancies are due to differences in evaluations of presurgery status, with retrospective evaluation yielding more favorable ratings than prospective assessment. The results highlight a variety of biases which may affect self-ratings of pre- and post-stressor adaptation and show that discrepancies associated with the two methodologies have important implications for understanding the impact of a stressor on adjustment.

[Diagnostic characteristics of the CA-50 and CA 72-4 tumor markers in body fluids. Use in the diagnosis of malignant effusions]. / Ispitivanje dijagnostickih karakteristika tumorskih markera CA-50 i CA 72-4 u telesnim tecnostima. Primena u dijagnostici malignih izliva.

The paper presents the results of a comparative investigation of CA-50 and CA 72-4 in the serum and effusions of the control group and a group of patients with various localizations of malignant tumors. The diagnostic applicability of CA-50 in the serum is limited by a substantial extent of falsely positive results, which is not the case with CA 72-4. Malignant cells make a more intensive release of CA 72-4 into effusions than into the blood, and the situation with CA-50 is reverse. It has been established that CA-50 in the serum and that CA 72-4 in effusions are complementary parameters. Markers in effusions have more favorable diagnostic characteristics in relation to serum. Although CA 72-4 is of a more superior diagnostic reliability, the examining of both markers is of help in the differentiation of benign peritoneal and pleural effusions from the malignant ones. The persistence of these markers in body fluids does not indicate the primary origin of malignant tumors.

[Primary liver carcinoma in the Subotica City Hospital 1962-1990]. / Primarni karcinom jetre u bolnici grada Subotice u periodu od 1962. do 1990. godine.

The authors have presented their observations in 108 pathologically processed cases of primary hepatic carcinoma (PHC). The material includes the period from 1962 to 1990. The most frequent form of PHC was hepatocellular (67.5%), the cholangiocellular (29.5%) and rarest, the mixed hepato-cholangiocellular form (2.9%). X-ray diagnostics were applied (celiacography, arteriography), laparoscopy, ultrasonography, aimed and blind aspirational biopsy, and laboratory examinations (alkaline phosphatase, transaminases, bilirubin, gamma-CT and so on). Somewhat more attention is given to the problem of HBV infection as the cause of primary hepatic carcinoma development. Pre-existing liver tissue diseases are also pleaded for (chronic aggressive hepatitis, hepatic cirrhosis, ect.). Beside the many diagnostic procedures, the diagnosis of primary hepatic carcinoma is usually established too late, and the therapy still remains unsatisfactory.

Prostatectomy and inguinal hernia repair: a comparison of the sexual consequences.

This study investigated whether psychosexual changes found after surgery for benign prostatic enlargement relate specifically to the prostatectomy procedure or to the stresses of surgery in general. The sexual adjustment of 91 married men (ranging in age from 51 to 77) who had undergone either transurethral prostatectomy or inguinal hernia repair was compared using the same measures and experimental design. Results show that both surgeries appeared to result in relatively minor but widespread negative consequences for sexual adjustment and expression. Findings on both individual and couple sexual adjustment suggest that the psychosexual consequences of the two procedures do not differ substantially. As expected, the one exception was retrograde ejaculation, which was more likely to be experienced by men who had undergone prostate surgery. The results illustrate the necessity of conducting comparative studies when evaluating the sexual consequences of surgical procedures and highlight the importance of taking age into consideration when conducting research on the effects of surgery on older men.

[The first scientific meeting in Subotica--August 27-31 1899]. / Prvi naucni sastanak u Subotici--27. VIII - 31. VIII 1899. godine.

The author brings out a brief survey of the development of Subotica as a city, and the development and achievements in it on a social and cultural scale during the 18th and 19th century. He states, that in the last decades of the past century, Subotica was a very strong economic and cultural center of this part of Vojvodina. Such a surrounding was offered, and afterwards it was decided upon, to organize an elite, professional and scientific manifestation--The Annual Meeting of Physicians and Naturalists of that--time Hungary. Here is an account of this First Scientific Meeting in Subotica, which was just the 30th Jubilee Meeting of the Physicians and Naturalists of Hungary. About 100 scientists took part in the work of this meeting, and 74 reports were presented. The holding of such a meeting in Subotica is, no doubt, an important moment in the cultural life of Subotica, and an especially important date in the development of the health service and science within it.

Transurethral prostatectomy: differential effects of age category and presurgery sexual functioning on postprostatectomy sexual adjustment.

Sexual functioning and adjustment of 72 aging married males who had undergone transurethral prostatectomy were examined retrospectively according to their pre- and postsurgery status. Results indicate that although transurethral prostatectomy was generally associated with deterioration in various aspects of sexual expression, grouping subjects according to age and presurgery sexual adjustment qualified these general findings dramatically. For example, more younger than older males retained or attained good sexual adjustment after surgery. Furthermore, while older males with good presurgery sexual adjustment maintained good couple sexual functioning, they manifested greater loss of sexual self-confidence and individual sexual capacity than did their younger counterparts. In addition, the findings suggest that the question "Does transurethral prostatectomy affect sexual function?" must be rephrased to take into account changes in the cognitive, capacity, and affective domains as well as in the couple behavior and adjustment dimensions of sexual expression.

Cognitions and sexual expression in the aging.

This study investigated the relation of cognitions to sexual expression in aging couples where the male had undergone transurethral prostatectomy. Cognitive factors explored were sexual efficacy expectations, value of sex, sexual attitudes, and sexual knowledge. Sexual expression was defined in terms of the following three dimensions: couple sexual frequency, desired sexual frequency, and quality of sexual functioning. Subjects consisted of 32 married couples whose ages ranged from 50 to 77 years. In this sample of sexually active couples, the cognitive variables most highly correlated with all the dimensions of sexual expression were efficacy expectations for the male's sexual performance and individual sexual drive. High sexual efficacy expectations predicted high couple sexual frequency and good male and female sexual functioning. High individual sexual drive predicted high actual and desired couple sexual interaction. In general, it was the male partner's sexual confidence and drive that was highly related to couple sexual expression.

[The value of ambulatory care in preventing and reducing invalidism due to eye pathology]. / Znachenie dispanserizatsii v profilaktike i snizhenii invalidnosti vsledstvie patologii organa zreniia.

The role and significance of dispensarization in solution of the problem of prevention and reduction of invalidity due to eye pathology are discussed. The analysis of epidemiologic and clinical data has revealed contingents with the highest factors of risk of invalidization requiring immediate dispensarization. Shortcomings and tasks of dispensarization of certain organized contingents are elucidated, of them pupils of schools for blind and poor-sighted children and invalids working at enterprises of societies of the blind. The necessity is emphasized to develop differentiated programmes for dispensarization as a valuable measure for prevention and reduction of blindness, poor vision and invalidity due to eye pathology.